Medicare Out of Pocket Maximum

This is Stan.  Stan is on medicare.  He’s been looking at health plans to see if there’s an affordable way to help pay some of the out of pocket expenses that medicare does not.  After doing his own research he discovers that there IS an affordable solution with some very reasonable copayments. It’s called a medicare advantage plan and it seems to have everything he was looking for.  It has dental benefits, and prescription coverage. It can help to pay for glasses and it even comes with a gym membership. Everything looks good until he notices it has something called maximum out of pocket allowance.  What is that, a deductible? Who’s got that kind of money lying around? Even worse is that every single one of these plans has got one. Every HMO or PPO that he comes across has one of those big deductibles so he gives up and goes back to using his medicare as he always has.

Sound familiar?

The problem is, that big deductible isn’t a deductible at all.  It’s called a maximum annual out of pocket and it’s a good thing.  In fact it might be the number one reason for you to take an advantage plan instead of staying with medicare alone.

Let’s take a look at why:

This is what Stan could pay in out of pocket expenses next year with Medicare.  If he’s in good health, he could pay as little a $0. But sometimes things come up, and more trips to see his doctor mean that more bills come along with it.

With the Advantage plan he’s going to see similar costs.  He’ll have copayments that make his expenses more predictable and a bit lower.  Just like with medicare how much he spends will depend how frequently he’s at the doctor.  But here’s difference: This advantage plan comes with a maximum annual out of pocket limit.  Its a stop loss that protects him in case he end up with more trips to the doctor than he was counting on.  It’s pure protection. That’s all. A protection that he DOESN”T have with medicare alone where more trips to the doctor just mean more bills to pay.

Now that he knows, he can go about finding which one of these plans will benefit him the most.  Stan called his agent for help and got signed up with an Advantage plan with all the benefits he was hoping and none of the worry.  Be like Stan. Find out for yourself what plans you have access to and what you’ve been missing out on.